Randomized Study of Combined Universal Family and School Preventive Interventions: Patterns of Long-Term Effects on Initiation, Regular Use, and Weekly Drunkenness.

This study reports findings on a combined family and school-based competency-training intervention from an in-school assessment 2.5 years past baseline, as a follow-up to an earlier study of substance initiation. Increased rates of observed alcohol use and an additional wave of data allowed evaluation of regular alcohol use and weekly drunkenness, with both point-in-time and growth curve analyses. Thirty-six rural schools were randomly assigned to (a) a combined family and school intervention condition, (b) a school-only condition, or (c) a control condition. The earlier significant outcome on a substance initiation index was replicated, and positive point-in-time results for weekly drunkenness were observed, but there were no statistically significant outcomes for regular alcohol use. Discussion focuses on factors relevant to the mix of significant longitudinal results within a consistent general pattern of positive intervention-control differences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents.

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot test of Project CHOICE: A voluntary afterschool intervention for middle school youth.

The current study reports findings from a pilot evaluation of a voluntary alcohol and marijuana intervention for young teens. Students at 2 middle schools completed 4 surveys over 2 years. During Year 2, an intervention, Project CHOICE (PC), was implemented at 1 school and was voluntarily attended by 13% of adolescents. Participants ranged from 10 to 15 years of age and were approximately 45% male, 45% White, 30% Latino, and 15% of mixed ethnic origin. Outcomes included assessments of self use and perceptions of friends' and schoolmates' past-month use of alcohol and marijuana. Analyses that compared PC participants (n=64) with a matched control sample of students (n=264) revealed that PC participants reported lower rates of alcohol use and lower perceptions of friends' marijuana use and of schoolmates' use of these substances. Random-effects growth models indicated that self use and perceptions of friends' use of alcohol and marijuana increased more sharply among control school students (n=178) relative to students from the PC school (n=270), regardless of participation. Results suggest that a brief voluntary intervention attended by a small proportion of students can impact both individual and schoolwide substance-related outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inhibition by gonadotropins of interleukin-1 production by rabbit granulosa and theca cells: effects on gonadotropin-induced progesterone production

BACKGROUND: School-based drug prevention programs have been criticized on methodologic grounds because the unit of analysis is often not the unit of randomization, thus increasing the likelihood of Type I errors. Application of multilevel analytic strategies appropriately corrects this biasing tendency. This study demonstrates the practical use of such analysis. METHODS: Data from 2,370 seventh-grade students participating in a substance use prevention trial were analyzed using a multilevel strategy. We examined the effectiveness of a social pressure resistance training and a normative education (NORM) intervention against an information-only control group. RESULTS: The NORM condition revealed 1-year program effects for cigarette and marijuana use with individuals as the unit of analysis and only marginal effects with classroom as the unit of analysis. No program effects were found using school as the analysis unit. A multilevel strategy revealed program effects for cigarettes and marijuana with both class and school as grouping levels. The effect for alcohol use was significant at the 2-year follow-up. CONCLUSIONS: Interventions establishing conservative drug use norms in classrooms may be an effective strategy in reducing substance use onset among adolescents. Utilization of appropriate analytic strategies is important in the analysis and interpretation of data containing nested structures.     

Age-related changes in reasons for using alcohol and marijuana from ages 18 to 30 in a national sample.

This study used up to seven waves of data from 32 consecutive cohorts of participants in the national longitudinal Monitoring the Future study to model changes in self-reported reasons for using alcohol and marijuana by age (18 to 30), gender, and recent substance use. The majority of stated reasons for use decreased in prevalence across young adulthood (e.g., social/recreational and coping with negative affect reasons); exceptions included age-related increases in using to relax (alcohol and marijuana), to sleep (alcohol), because it tastes good (alcohol), and to get high (marijuana). Women were more likely than men to report drinking for reasons involving distress (i.e., to get away from problems), while men were more likely than women to endorse all other reasons. Greater substance use at age 18 was associated with greater likelihood of all reasons except to experiment and to fit in. A better understanding of developmental changes in reasons for use is important for understanding normative changes in substance use behaviors and for informing intervention efforts involving underlying reasons for use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Demographic, individual, and interpersonal predictors of adolescent alcohol and marijuana use following treatment.

A vulnerability model of adolescent substance abuse treatment outcome provided the basis for selection of demographic, individual, interpersonal, and treatment factors to predict the follow-up use of alcohol and marijuana in a sample of 225 adolescents (aged 12–18 yrs) with psychoactive substance use disorders. Pretreatment levels of sibling substance use and aftercare participation predicted alcohol and marijuana use during the first 6 mo posttreatment. Pretreatment levels of deviant behavior also predicted the use of marijuana at 6-mo follow-up. Peer substance use at intake and 6-mo posttreatment both predicted substance use frequency outcomes at 12-mo follow-up. Alcohol and marijuana use frequencies at 6-mo follow-up also predicted continued use for these substances throughout the remainder of the 1st posttreatment year. Shorter treatment length and being male were risk factors for alcohol use during the 2nd half of the 1st posttreatment year. Elevated psychological substance dependence at 6-mo follow-up was a unique risk factor for subsequent marijuana use. Findings support conceptual models that attempt to explain adolescent substance abuse treatment outcome in terms of relationships among demographic, individual, interpersonal, and treatment factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An adaptive approach to family intervention: Linking engagement in family-centered intervention to reductions in adolescent problem behavior.

This study used Complier Average Causal Effect analysis (CACE; see G. Imbens & D. Rubin, 1997) to examine the impact of an adaptive approach to family intervention in the public schools on rates of substance use and antisocial behavior among students ages 11-17. Students were randomly assigned to a family-centered intervention (N = 998) in 6th grade and offered a multilevel intervention that included (a) a universal classroom-based intervention, (b) the Family Check-Up (selected; T. J. Dishion & K. Kavanagh, 2003), and (c) family management treatment (indicated). All services were voluntary, and approximately 25% of the families engaged in the selected and indicated levels. Participation in the Family Check-Up was predicted by 6th-grade teacher ratings of risk, youth reports of family conflict, and the absence of biological fathers from the youths' primary home. Relative to randomized matched controls, adolescents whose parents engaged in the Family Check-Up exhibited less growth in alcohol, tobacco, and marijuana use and problem behavior during ages 11 through 17, along with decreased risk for substance use diagnoses and police records of arrests by age 18. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expecting innovation: Psychoactive drug primes and the generation of creative solutions.

Many individuals expect that alcohol and drug consumption will enhance creativity. The present studies tested whether substance related primes would influence creative performance for individuals who possessed creativity-related substance expectancies. Participants (n = 566) were briefly exposed to stimuli related to psychoactive substances (alcohol, for Study 1, Sample 1, and Study 2; and marijuana, for Study 1, Sample 2) or neutral stimuli. Participants in Study 1 then completed a creative problem-solving task, while participants in Study 2 completed a divergent thinking task or a task unrelated to creative problem solving. The results of Study 1 revealed that exposure to the experimental stimuli enhanced performance on the creative problem-solving task for those who expected the corresponding substance would trigger creative functioning. In a conceptual replication, Study 2 showed that participants exposed to alcohol cues performed better on a divergent thinking task if they expected alcohol to enhance creativity. It is important to note that this same interaction did not influence performance on measures unrelated to creative problem solving, suggesting that the activation of creativity-related expectancies influenced creative performance, specifically. These findings highlight the importance of assessing expectancies when examining pharmacological effects of alcohol and marijuana. Future directions and implications for substance-related interventions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predictors of overall and on-the-job substance use among young workers.

Predictors of overall and on-the-job substance (alcohol and marijuana) use were studied in a sample of young workers. The 18 predictors represent 6 general domains of risk factors: demographic, personality, substance use outcome expectancies, workplace substance availability, workplace social control, and work stressors. Data were obtained from a sample of 319 individuals ages 16 to 19. Hierarchical tobit regression analyses revealed that 5 of the 6 domains of risk factors were related to employee substance use. Similarities and differences were found in the predictors of overall and on-the job substance use and in the predictors of alcohol and marijuana use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance abuse and the emergency room: programmatic implications

A literature review (1984 to 1995) was conducted to identify cost effective policy implications regarding substance use in the emergency room (ER) and trauma unit. Prevalence rates, ranging from 9% to 47%, vary according to where, when and who is tested. Other drugs, most commonly marijuana, benzodiazepines and cocaine, follow a similar pattern to alcohol. The optimal method of measuring substance use depends on the goal of the assessment and a combination of clinical, self-report and biochemical markers is recommended. Simple screening questions such as the TWEAK or AUDIT should be routinely used with all attendants and further assessment provided only when high risk factors have been identified. These include: males, younger patients, metropolitan centres, after midnight and on weekends, injury from violence, accidents including MVAs, high acuity and psychiatric morbidity. Further, this screening should be complimented by an intervention, referral and treatment resource for those in need.     

Randomized trial of brief family interventions for general populations: Adolescent substance use outcomes 4 years following baseline.

This study examined the long-term substance use outcomes of 2 brief interventions designed for general population families of young adolescents. Thirty-three public schools were randomly assigned to 3 conditions: the 5-session Preparing for the Drug Free Years Program, the 7-session Iowa Strengthening Families Program, and a minimal contact control condition. The pretest involved 667 6th graders and their families. Assessments included multiple measures of initiation and current use of alcohol, tobacco, and marijuana. Pretest data were collected in the 6th grade and the reported follow-up data were collected in the 10th grade. Significant intervention-control differences in initiation and current use were found for both interventions. It is concluded that brief family skills-training interventions designed for general populations have the potential to reduce adolescent substance use and thus have important public health implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress, expectancies, and vulnerability to substance abuse: A test of a model among homosexual men.

We hypothesize that specific attitudes or expectancies make people vulnerable to responding to stress via alcohol or drugs. This "stress-vulnerability" model was tested among homosexual men, who show elevated rates of substance abuse and have culturally specific stressors and vulnerability. Tension reduction expectancies of alcohol effects had a substantial effect on alcohol and marijuana/drug abuse, as did the use of bars as a social resource. Two stress variables—negative affectivity and discrimination attributable to sexual orientation—also had significant, though more moderate effects. Interactions of the vulnerability measures with the stress variables had significant effects on substance abuse beyond the main effects, supporting the central hypothesis. In a second analysis both simple consumption levels and "high-risk" styles of alcohol or drug use predicted alcohol or drug problems better among vulnerable than among nonvulnerable respondents. These findings strongly supported a general stress-vulnerability model of substance abuse and illustrated several important risk factors in homosexual culture. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latent growth trajectories of substance use among pregnant and parenting adolescents.

We examine changes among adolescent girls in substance use during pregnancy and the postpartum period. Three separate latent growth curve analyses assessed the impact of psychosocial, behavioral, and sociodemographic factors on resumption of or change in use of cigarettes, alcohol, and marijuana. The Vulnerable Populations Model for Research and Clinical Practice (Flaskerud & Winslow, 1998) provided the theoretical foundation for this study. This is a secondary analysis of data from a sample of 305 ethnic minority females (245 Latina, 60 African American), aged 13–18 years, who were pregnant at baseline and were participating in an HIV prevention study conducted in inner-city alternative schools in Los Angeles County. Data collected at 4 time points captured changes in substance use from pregnancy through the postpartum period. Baseline predictors included ethnicity/race, partner substance use, childhood abuse history, religiosity, acculturation, depressive symptoms, length of gestation at baseline, and previous substance use. Common predictors of greater resumption and/or greater level of use included greater history of use before pregnancy, partner substance use, childhood abuse, and a longer time since childbirth. African Americans were more likely to be smoking at baseline when they were still pregnant and to use marijuana postpartum; Latinas were more likely to use alcohol over the course of pregnancy and postpartum. Other variables exerted an influence on specific substances. For instance, religiosity impacted cigarette and alcohol use. Findings may assist prenatal care providers to identify and counsel pregnant adolescents at risk for perinatal substance use and to prevent resumption or initiation of substance use after childbirth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Buffering effect of religiosity for adolescent substance use.

This research examined the hypothesis that religiosity buffers the impact of life stress on adolescent substance use. Data were from a sample of 1,182 participants surveyed on 4 occasions between 7th grade (mean age = 12.4 years) and 10th grade. Religiosity was indexed by Jessor's Value on Religion Scale (R. Jessor & S. L. Jessor, 1977). Zero-order correlations showed religiosity inversely related to alcohol, tobacco, and marijuana use. Significant Life Events×Religiosity buffer interactions were found in cross-sectional analyses for tobacco, alcohol, and marijuana use. A latent growth analysis showed that religiosity reduced the impact of life stress on initial level of substance use and on rate of growth in substance use over time. Implications for further research on religiosity and substance use are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescents' thoughts about abstinence curb the return of marijuana use during and after treatment.

Despite evidence showing that readiness to change substance use predicts reductions in substance use among treated adolescents, there is little research on changes in thoughts about abstinence and marijuana use during and after treatment. The current study tested whether time-varying changes in adolescents’ motivation to abstain and perceived difficulty to abstain from marijuana use hinder the return of regular marijuana use during and after treatment. Monthly data on thoughts about abstinence, marijuana use, and treatment utilization were collected over 6 months from 142 adolescents recruited from intensive outpatient substance use treatment. Results indicated that higher motivation to abstain (but not perceived difficulty) predicted fewer days of marijuana use, over and above the individual’s average trajectory of marijuana use, the initial severity of marijuana involvement, and the effects of treatment utilization. Moreover, past-month marijuana use influenced both motivation to abstain and perceived difficulty to abstain. Findings highlight the importance of abstinence-related cognitions as a target of intervention during and after treatment and underscore the importance of considering recovery from substance use disorders as a dynamic process of change over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Familial transmission of substance dependence: alcohol, marijuana, cocaine, and habitual smoking: a report from the Collaborative Study on the Genetics of Alcoholism

BACKGROUND: Alcoholism and substance dependence frequently co-occur. Accordingly, we evaluated the familial transmission of alcohol, marijuana, and cocaine dependence and habitual smoking in the Collaborative Study on the Genetics of Alcoholism. METHODS: Subjects (n=1212) who met criteria for both DSM-III-R alcohol dependence and Feighner definite alcoholism and their siblings (n=2755) were recruited for study. A comparison sample was also recruited (probands, n=217; siblings, n=254). Subjects were interviewed with the Semi-Structured Assessment for the Genetics of Alcoholism. The familial aggregation of drug dependence and habitual smoking in siblings of alcohol-dependent and non-alcohol-dependent probands was measured by means of the Cox proportional hazards model. RESULTS: Rates of alcohol, marijuana, and cocaine dependence and habitual smoking were increased in siblings of alcohol-dependent probands compared with siblings of controls. For siblings of alcohol-dependent probands, 49.3% to 50.1% of brothers and 22.4% to 25.0% of sisters were alcohol dependent (lifetime diagnosis), but this elevated risk was not further increased by comorbid substance dependence in probands. Siblings of marijuana-dependent probands had an elevated risk of developing marijuana dependence (relative risk [RR], 1.78) and siblings of cocaine-dependent probands had an elevated risk of developing cocaine dependence (RR, 1.71). There was a similar finding for habitual smoking (RR, 1.77 in siblings of habitual-smoking probands). CONCLUSIONS: Alcohol, marijuana, and cocaine dependence and habitual smoking are all familial, and there is evidence of both common and specific addictive factors transmitted in families. This specificity suggests independent causative factors in the development of each type of substance dependence.     

Self-coded indirect memory associations in a brief school-based intervention for substance use suspensions.

This study assessed the concurrent validity of self-generated and self-coded substance use associations for marijuana and alcohol use. Grades seven to twelve students were assessed as part of a brief intervention program in lieu of suspension for substance use infractions in school. During the cognitive assessment, students generated memory associations to probes for high-risk situations and desirable outcomes. Later, the participant rated their responses according to categories including both non-risk and substance use. Three different coding methods were compared: (1) conservative codes using clearly unambiguous responses, (2) liberal scores adding ambiguous, but likely responses, and (3) self-coded. Self-coded scores were higher, had stronger correlations with substance use, and were better predictors of substance use and problems than either conservative or liberal coded scores. These findings suggest that self-coding may be used to improve concurrent validity, decrease ambiguities in coding, and reduce the cost of measuring memory associations. The present method promises a cost effective and valid measure of indirect substance use cognitions that can be readily adapted for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parallel developmental trajectories of sensation seeking and regular substance use in adolescents.

This study applied piecewise latent growth modeling to longitudinal survey data from 2 different samples of adolescents (N=1,002 and N=1,206) to examine the hypothesis that development of sensation seeking in middle school would predict development of substance use (cigarettes, alcohol, and marijuana) in middle school and high school. Results showed that sensation seeking had strong predictive value for both concurrent and distal marijuana and alcohol use in both samples; however, initial level of sensation seeking predicted initial level of cigarette use during high school in 1 sample only. White participants scored consistently higher on both initial level and rate of increase in sensation seeking than did participants of other ethnicities. Advantages of this methodology are discussed in the context of substance use research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Associations of substance use problems with intimate partner violence for at-risk men in long-term relationships.

Associations of substance use problems in men--defined as a man's meeting at least 1 criterion of dependence on each of a number of substances by his mid-20s--with their perpetration of intimate partner violence (IPV) were examined in an at-risk community sample of 150 men in long-term relationships from their late adolescence to their late 20s. Men who had a problem with substances other than sedatives (especially cannabis and hallucinogens) committed more IPV than did men without such problems. Most of the men who had a problem with marijuana also had an alcohol problem, which explains why alcohol was found to have only an indirect association with IPV. The failure of previous alcohol-use studies to control for co-occurrence of alcohol and marijuana problems may explain the discrepancy with conclusions from past research that alcohol problems contribute directly to the perpetration of IPV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)